Dynisty’s Tax Service Client Forms

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
DOB
Spouse Information
Cell
Spouse Information
1. DID YOU PAID ALIMONY?
3. DID YOU BUY SELL OR REFINANCE A PERSONAL HOME?
2. Unemployment (Form 1099 G) 3. Alimony
2. DID YOU MAKE IRA CONTRIBUTION
1. # OF W 2s
Email
Spouse Information
3. Alimony
4. Pension Income (Form 1099R)
5. (FORM 1098-T) STUDENT LOAN INTEREST?
8. Lottery/Gambling
4. DID YOU PAY TUITION EXPENSES?
5. Social Security Benefits (SSA 1099)
7. Child Support
6. Interest Income (Form 1099 INT)
If No please give reason

Rows	Yes or No
You cared for the child/children as you would your own child
The child/children lived with you for the entire year except for temporary absences
The child/children was/were placed in your care by a state, one subdivision,or placement agency

10. Any other income
If yes Please list it here
I do authorize Dynisty's Tax Service prepare my Tax Return, Please Initial below
Put first and last name initial above!
CUSTOMER DATA SHEET

DTS
The undersigned person(s) has/have authorized the Dynisty’s Tax Service and its authorized representative in Person of

First NameLast Name
PLEASE FILL OUT THIS FORM COMPLETELY; ASK FOR HELP IF NECESSARY
Please upload all Documents such as ID, SSN Cards (Birth Certificates ETC If you have business documents (Ein, LLC, State Registry) W2 1099s

Cancelof
Type a question
Childcare Information
Name of provider
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name

First NameLast Name
DOB
Spouse Information
Type a question
This is a fill in the blanks field. Please add appropriate blank fields and text.
Type a question
Please let us know if you would like to see a specific agent Tax Agent
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Spouse's Signature
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date oF Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
SSN
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Source Of Income
9. Self Employment
Please type Yes or NO

Type a question

Rows	Full Name	DOB	SSN	Months Stayed	Realtionship
1.
2.
3.
4.
5.

Number of expected w2
Cash Advance?
Option 1 is up to $1000 no interest Option 2 is up to $6000 with interest! Please type YES or NO with an option!
Full Name
Please type full name
DEPENDENT(S) INFORMATION AS IT IS EXACTLY ON SOCIAL SECURITY CARD
Do u have custody of the dependent(s) listed on your tax return
DID THE DEPENDENT LIVE WITH YOU FOR MORE THAN 6 MONTHS

DEPENDENT'S INFORMATION

Rows	Name	DOB	DID THEY DEPENDENT LIVE WITH YOU FOR MORE THAN 6 MONTHS / REALTIONSHP
1.
2.
3.
4.

If you are not Biological parent(s), do you have authority to use the dependent(s) listed on your tax return?
If No, please explain:
Are there anyone other than you who may claim the dependent(s) listed on your return?
Can anybody claim you as a dependent on their tax return?
If Yes, please list whom and relationship
METHOD OF PAYMENT

All fee's will be withheld from whichever refunds (state or federal) comes first !
Please complete every part of document; ask for help if you need to.
Please select payment method

Please enter Direct Deposit Information below

Rows	Banking Information
Routing
Account

Please answer all questions below......

Rows	yes or no
Do you have any outstanding Federal Tax Liabilities?
Do you have any other liabilities such as child support or student loans?
Do you give us permission to check for any outstanding tax liabilities ? (If no then your payment will be due upfront )

Alternate Eligibility Record (Due Diligence)

Head Of Household Eligibility You may file Head of Household if you can answer YES to ALL the following questions. (See publication 17 Chap 2&3)

Rows	Yes Or No
You are unmarried, or are considered unmarried on the last day of the year?
You paid more than half the cost of keeping up a home for the year
A qualifying person (Definition below) lived with you in the same home for more than half the year (except temporary absences, such as school) and you can claim an exemption for him/her except as noted under Category 3 below

Qualifying person requirements are: (See table 2.1 Publication 17)

1. A qualifying relative such as a parent, grandparent, brother, sister, stepbrother, stepsister, stepmother, stepfather, father-in-law, half-brother, half-sister, brother-in-law, sister-in-law, daughter-in-law,uncle, aunt, nephew, or neice who is related to you by blood and lived with you the entire year.

2. Child, Grandchild, stepchild, or adopted child.

3. Eligible foster child ( Note. For eligbilty for dependnet only a foster child is a child who is in your care, that you care for as your own child and who lived with you the entire year, it does not matter how the child became a member of the household)
EARNED INCOME CREDIT (EIC) ELGIBILTY

You may claim the EIC if you can answer YES to ALL 4 tests below (See publications 17 Chapter 36)

Rows	Yes or No
1. Relationship Test Your child/children is/are one of the following: a son, daughter, adopted child, stepchild, grandchild, or eligible foster child or is your brother, sister, stepbrother, stepsister, (or the child or grandchild of your brother, sister, stepbrother, or stepsister) and you care for it/them as you would your own child.
2. Age Test Your child/children is/are under 19 years of age at the end of the year or is under 24 years of age at the end of the year and is a full-time student or was permanently and totally disabled at any time during the tax year, regardless of age.
3. Residency Test Your child/children lived with you for more than half the year (or the whole year if an eligible foster child)
Your home is located in the United States
4. Qualifying child or another Test If your child/children is/are the qualifying child/children of another individual, you are the only person claiming the credit for that/those child/children during the tax year. (Note: If the answer is NO, refer to the tiebracker rule, You may still be able to take the credit.

DOB
I attest and affirm that the information provided to compare this Eligibilty Checklist is true and correct to the best of my knowledge, I understand the IRS may randomly question eligbilyt and that if my tax return is randomly selected for review, that my return, refund, direct deposit, or any combination thereof may be delayed or denied.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1. # OF W 2s
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
The undersigned person(s) has/have authorized the Dynisty’s Tax Service and its authorized representative in Person of

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
File Upload

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Number
Email
example@example.com

Type a question

Rows	Not Satisfied	Somewhat Satisfied	Satisfied	Very Satisfied
Service Quality
Cleanliness
Responsiveness
Friendliness

Type a question

Rows	Full Name	DOB	SSN	Months Stayed	Realtionship
1.
2.
3.
4.
5.
6.
7.
8.
9.

Type a question
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type a question
Type a question
Type a question
Please upload all Documents such as ID, SSN Cards (Birth Certificates ETC If you have business documents (Ein, LLC, State Registry) W2 1099s

Cancelof
Type a question
Type a question
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tax Payer Signature
Type a question
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
DOB
Type a question
Type a question
Type a question
Type a question
Type a question
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please upload A VALID ID, SOCIAL'S/BIRTH CERTIFICATE, EIN, LLC (If applicable),W2, 1098t For school, 1099's, utility bill

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Todays Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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Type a question
Type a question
Type a question
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Type a question
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Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Type a question
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Spouse's Full Name
Spouse Information
Type a question
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
File Upload

Cancelof

Type a question

Rows	Not Satisfied	Somewhat Satisfied	Satisfied	Very Satisfied
Service Quality
Cleanliness
Responsiveness
Friendliness

Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number
Type a question
Email
SSN
Cell
Please select one
SSN
Spouse Information
Should be Empty:

CUSTOMER DATA SHEET

PLEASE FILL OUT THIS FORM COMPLETELY; ASK FOR HELP IF NECESSARY

Source Of Income

DEPENDENT(S) INFORMATION AS IT IS EXACTLY ON SOCIAL SECURITY CARD

METHOD OF PAYMENT

Alternate Eligibility Record (Due Diligence)

EARNED INCOME CREDIT (EIC) ELGIBILTY